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SUMMARY OF BENEFITS

Atkins / Faithful+Gould Dental PPO Plan


Effective June 1, 2010 All deductibles, plan maximums, and service specific maximums (dollar and occurrence) cross accumulate between in and out of network.

In-Network
Calendar Year Maximum (Class I, II and III expenses) Annual Deductible Individual Family Reimbursement Levels** $2,000 $50 per person $150 per family Based on Reduced Contracted Fees Plan Pays 100% You Pay No Charge

Out-of-Network
$2,000 $50 per person $150 per family 90th percentile of Reasonable and Customary Allowances Plan Pays You Pay 100% No Charge

Class I - Preventive & Diagnostic Care Oral Exams Routine Cleanings Bitewing X-rays Full Mouth X-rays Panoramic X-ray Fluoride Application Sealants Space Maintainers Class II - Basic Restorative Care Fillings Root Canal Therapy/Endodontics Osseous Surgery Periodontal Scaling and Root Planing Surgical Extractions of Impacted Teeth Emergency Care to Relieve Pain Brush Biopsies Oral Surgery - all except simple extractions Anesthetics Oral Surgery Simple Extractions Class III - Major Restorative Care Crowns Histopathologic Exams Denture Repairs Denture Relines, Rebases and Adjustments Repairs to Bridges, Crowns and Inlays Dentures Bridges Inlays/Onlays Prosthesis Over Implant Class IV - Orthodontia Lifetime Maximum

80%*

20%*

80%*

20%*

50%*

50%*

50%*

50%*

50%* $2,000 Dependent children to age 19

50%*

50%* $2,000 Dependent children to age 19

50%*

Exhibit for Open Enrollment purpose only. Refer to the Summary Plan Description for specific details. Page 1 of 2

SUMMARY OF BENEFITS
Atkins / Faithful+Gould Dental PPO Plan
Effective June 1, 2010 Missing Tooth Limitation Teeth missing prior to coverage under the CIGNA Dental plan are not covered. Pretreatment review is available on a voluntary basis when extensive dental work in excess of $200 is proposed. *Subject to annual deductible **For services provided by a CIGNA Dental PPO network dentist, CIGNA Dental will reimburse the dentist according to a Contracted Fee Schedule. For services provided by an out-of-network dentist, CIGNA Dental will reimburse according to Reasonable and Customary Allowances but the dentist may balance bill up to their usual fees. These are only the highlights This summary outlines the highlights of your plan. For a complete list of both covered and not-covered services, including benefits required by your state, see your employer's insurance certificate or summary plan description -the official plan documents. If there are any differences between this summary and the plan documents, the information in the plan documents takes precedence.

Exhibit for Open Enrollment purpose only. Refer to the Summary Plan Description for specific details. Page 2 of 2

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